Christopher S Ogilvy

Beth Israel Deaconess Medical Center, Boston, Massachusetts, United States

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Publications (338)1091.74 Total impact

  • Robert A. Solomon · Matthew R. Fusco · Christopher S. Ogilvy ·

    Neurosurgery 06/2014; 10:251-251. · 3.62 Impact Factor
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    ABSTRACT: Purpose/Objective(s) To evaluate the obliteration rate and potential adverse effects of single-fraction proton beam stereotactic radiosurgery (PSRS) in patients with cerebral arteriovenous malformations (AVMs). Methods and Materials From 1991 to 2010, 248 consecutive patients with 254 cerebral AVMs received single-fraction PSRS at our institution. The median AVM nidus volume was 3.5 cc (range, 0.1-28.1 cc), 23% of AVMs were in critical/deep locations (basal ganglia, thalamus, or brainstem), and the most common prescription dose was 15 Gy(relative biological effectiveness [RBE]). Univariable and multivariable analyses were performed to assess factors associated with obliteration and hemorrhage. Results At a median follow-up time of 35 months (range, 6-198 months), 64.6% of AVMs were obliterated. The median time to total obliteration was 31 months (range, 6-127 months), and the 5-year and 10-year cumulative incidence of total obliteration was 70% and 91%, respectively. On univariable analysis, smaller target volume (hazard ratio [HR] 0.78, 95% confidence interval [CI] 0.86-0.93, P<.0001), smaller treatment volume (HR 0.93, 95% CI 0.90-0.96, P<.0001), higher prescription dose (HR 1.16, 95% CI 1.07-1.26, P=.001), and higher maximum dose (HR 1.14, 95% CI 1.05-1.23, P=.002) were associated with total obliteration. Deep/critical location was also associated with decreased likelihood of obliteration (HR 0.68, 95% CI 0.47-0.98, P=.04). On multivariable analysis, critical location (adjusted HR [AHR] 0.42, 95% CI 0.27-0.65, P<.001) and smaller target volume (AHR 0.81, 95% CI 0.68-0.97, P=.02) remained associated with total obliteration. Posttreatment hemorrhage occurred in 13 cases (5-year cumulative incidence of 7%), all among patients with less than total obliteration, and 3 of these events were fatal. The most common complication was seizure, controlled with medications, both acutely (8%) and in the long term (9.1%). Conclusions The current series is the largest modern series of PSRS for cerebral AVMs. PSRS can achieve a high obliteration rate with minimal morbidity. Post-treatment hemorrhage remains a potentially fatal risk among patients who have not yet responded to treatment.
    International journal of radiation oncology, biology, physics 06/2014; 89(2). DOI:10.1016/j.ijrobp.2014.02.030 · 4.26 Impact Factor

  • Neurosurgery 05/2014; 75(2). DOI:10.1227/NEU.0000000000000418 · 3.62 Impact Factor
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    ABSTRACT: To investigate the frequency, predictors, and clinical impact of electrographic seizures in patients with high clinical or radiologic grade non-traumatic subarachnoid hemorrhage (SAH), independent of referral bias. We compared rates of electrographic seizures and associated clinical variables and outcomes in patients with high clinical or radiologic grade non-traumatic SAH. Rates of electrographic seizure detection before and after institution of a guideline which made continuous EEG monitoring routine in this population were compared. Electrographic seizures occurred in 17.6 % of patients monitored expressly because of clinically suspected subclinical seizures. In unselected patients, seizures still occurred in 9.6 % of all cases, and in 8.6 % of cases in which there was no a priori suspicion of seizures. The first seizure detected occurred 5.4 (IQR 2.9-7.3) days after onset of subarachnoid hemorrhage with three of eight patients (37.5 %) having the first recorded seizure more than 48 h following EEG initiation, and 2/8 (25 %) at more than 72 h following EEG initiation. High clinical grade was associated with poor outcome at time of hospital discharge; electrographic seizures were not associated with poor outcome. Electrographic seizures occur at a relatively high rate in patients with non-traumatic SAH even after accounting for referral bias. The prolonged time to the first detected seizure in this cohort may reflect dynamic clinical features unique to the SAH population.
    Neurocritical Care 04/2014; 21(3). DOI:10.1007/s12028-014-9974-y · 2.44 Impact Factor
  • Silvia Hernández-Durán · Christopher S Ogilvy ·
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    ABSTRACT: The purpose of this study was to present a meta-analysis on the safety and efficacy of different endovascular modalities when treating vertebral artery dissections, since ideal treatment remains controversial. We performed a meta-analysis of 39 retrospective studies involving different treatment modalities for vertebral artery dissections in adults and obtained weighted pooled proportional outcome and mortality ratios with a random effects model. Overall, 75.11 % (confidence interval (CI) 68.89–80.84, I 2 66.89 %) had excellent outcomes, 10.10 % (CI 6.83–15.56, I 2 65.64 %) had good outcomes, and 13.70 % (CI 9.64–18.35, I 2 60.33 %) had poor outcomes. Postoperative complications occurred in 10.52 % (CI 6.87–14.84, I 2 62.48 %), with 2.73 % (CI 1.64–4.10, I 2 0.0 %) exhibiting vasospasm, 3.03 % (CI 1.88–4.46, I 2 0.0 %) experiencing postoperative rebleeding, and 6.31 % (CI 3.57–9.76, I 2 60.92 %) showing ischemia. Overall mortality was 8.69 % (CI 6.13–11.64, I 2 33.76 %). When compared to these overall ratios, different treatment modality subgroups did not differ significantly, except for the proximal occlusion group, with poor outcome ratio = 26.96 % (difference 13.26, CI 0.02–30.04, p = 0.0403) and mortality ratio = 21.36 % (difference 12.67, CI 0.94–28.86, p = 0.0189). Different endovascular treatment modalities are comparatively safe and effective in the management of vertebral artery dissection. Their reduced operative time, minimal invasiveness, and overall safety render them a suitable option for intervention-amenable dissections.
    Neurosurgical Review 04/2014; 37(4). DOI:10.1007/s10143-014-0541-y · 2.18 Impact Factor
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    ABSTRACT: Indices of the intra-aneurysm hemodynamic environment have been proposed as potentially indicative of their longitudinal outcome. To be useful, the indices need to be used to stratify large study populations and tested against known outcomes. The first objective was to compile the diverse hemodynamic indices reported in the literature. Furthermore, as morphology is often the only patient-specific information available in large population studies, the second objective was to assess how the ranking of aneurysms in a population is affected by the use of steady flow simulation as an approximation to pulsatile flow simulation, even though the former is clearly non-physiological. Sixteen indices of aneurysmal hemodynamics reported in the literature were compiled and refined where needed. It was noted that, in the literature, these global indices of flow were always time-averaged over the cardiac cycle. Steady and pulsatile flow simulations were performed on a population of 198 patient-specific and 30 idealised aneurysm models. All proposed hemodynamic indices were estimated and compared between the two simulations. It was found that steady and pulsatile flow simulations had a strong linear dependence (r ≥ 0.99 for 14 indices; r ≥ 0.97 for 2 others) and rank the aneurysms in an almost identical fashion (ρ ≥ 0.99 for 14 indices; ρ ≥ 0.96 for other 2). When geometry is the only measured piece of information available, stratification of aneurysms based on hemodynamic indices reduces to being a physically grounded substitute for stratification of aneurysms based on morphology. Under such circumstances, steady flow simulations may be just as effective as pulsatile flow simulation for estimating most key indices currently reported in the literature.
    Computer Methods in Biomechanics and Biomedical Engineering 02/2014; 18(10). DOI:10.1080/10255842.2013.869322 · 1.77 Impact Factor
  • Pankaj K Agarwalla · Christopher J Stapleton · Christopher S Ogilvy ·
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    ABSTRACT: : Anterior and posterior circulation acute ischemic stroke carries significant morbidity and mortality as a result of malignant cerebral edema. Decompressive craniectomy has evolved as a viable neurosurgical intervention in the armamentarium of treatment options for this life-threatening edema. In this review, we highlight the history of craniectomy for stroke and discuss recent data relevant to its efficacy in modern neurosurgical practice. DC, decompressive craniectomyHAMLET, Hemicraniectomy After Middle Cerebral Artery infarction With Life-threatening Edema TrialICP, intracranial pressureMCA, middle cerebral arterySTATE, score, time, age, territory, and expectations.
    Neurosurgery 02/2014; 74 Suppl 1(2):S151-S162. DOI:10.1227/NEU.0000000000000226 · 3.62 Impact Factor
  • Donnie L Bell · Christopher J Stapleton · Anna R Terry · James R Stone · Christopher S Ogilvy ·
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    ABSTRACT: Spinal artery pseudoaneurysms are rare vascular lesions with poorly defined natural history, diagnostic paradigms, and treatment strategies. We present a 68-year-old woman with severe back pain and left lower extremity weakness with spinal subarachnoid hemorrhage due to a ruptured T5 region posterior spinal artery pseudoaneurysm, and review issues related to radiologic diagnosis and endovascular and open neurosurgical interventions.
    Journal of Clinical Neuroscience 01/2014; 21(7). DOI:10.1016/j.jocn.2014.01.002 · 1.38 Impact Factor
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    ABSTRACT: For cerebral arteriovenous malformations (AVMs) determined to be high risk for surgery or endovascular embolization, stereotactic radiosurgery (SRS) is considered the mainstay of treatment. To determine the outcomes of pediatric patients with AVMs treated with proton SRS. We reviewed the records of 44 consecutively treated pediatric patients (age < 18) who underwent proton SRS at our institution from 1998-2010. The median target volume was 4.5±5.9 mL (range= 0.3-29.0 mL) and the median maximal diameter was 3.6± 1.5 cm (range =1-6 cm). Radiation was administered with a median prescription dose of 15.50±1.87 CGE to the 90% isodose. At a median follow-up of 52±25 months, two patients (4.5%) had no response, 24 patients (59.1%) had a partial response, and 18 patients (40.9%) experienced obliteration of their AVM. The median time to obliteration was 49±26 months, inclusive of 17 patients who underwent repeat proton radiosurgery. Four patients (9%) experienced hemorrhage following treatment at a median time of 45±15 months. Univariate analysis identified modified AVM scale score (p=0.045), single fraction treatment (0.04), larger prescription dose (0.01), larger maximum dose (<0.001), and larger minimum dose (0.01) to be associated with AVM obliteration. High-risk AVMs can be safely treated with proton radiosurgery in the pediatric population. Since protons deposit energy more selectively than photons, there is the potential benefit of protons to lower the probability of damage to healthy tissue in the developing brain.
    Neurosurgery 01/2014; 74(4). DOI:10.1227/NEU.0000000000000294 · 3.62 Impact Factor
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    ABSTRACT: Carotid body tumors (CBT) are rare neuroendocrine neoplasms that usually present in the third or fourth decades of life and are benign in more than 95% of cases. In the angiographic literature, the arterial supply to carotid body tumors is well documented but is often incomplete, with infrequent mention of the glomic artery, a common arterial feeder described in the anatomic and pathologic literature. Through a review of our neuroendovascular patient database, we identified eight patients with CBT undergoing transarterial embolization followed by resection. Mean patient age was 51.5years (range 29-82), and all patients were female. Mean tumor size was 91.2cc (standard deviation [SD] 61.1, median 67.7cc). After embolization, greater than 90% flow reduction was achieved in 5/8 patients (63%); 60-80% flow reduction was achieved in the remaining patients. Mean operative blood loss was 166cc (SD 100, median 122cc) and mean operative time was 252minutes (SD 134.5, median 155minutes). Pre-embolization angiography was reviewed to identify a glomic artery, defined as a dominant artery supplying the CBT arising from the region of the carotid bifurcation. In six of eight patients (75%) a glomic artery could be identified, arising from the common carotid artery in 4/6 patients and the external carotid artery in 2/6 patients. Thus, glomic artery to supply to CBT was identified in the majority of patients in this series. Knowledge of its presence and identification as a direct supplier, frequently from the common carotid artery itself, provides an avenue for more thorough preoperative embolization of CBT.
    Journal of Clinical Neuroscience 12/2013; 21(7). DOI:10.1016/j.jocn.2013.11.012 · 1.38 Impact Factor
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    ABSTRACT: While Onyx embolization of cerebrospinal arteriovenous shunts is well-established, clinical researchers continue to broaden applications to other vascular lesions of the neuraxis. This report illustrates the application of Onyx (eV3, Plymouth, MN) embolization to vertebral body lesions, specifically, a vertebral hemangioma and renal cell carcinoma vertebral body metastatic lesion.
    12/2013; 15(4):320-5. DOI:10.7461/jcen.2013.15.4.320
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    ABSTRACT: Cerebral hyperperfusion syndrome is a well-recognized and potentially fatal complication of carotid revascularization. However, the occurrence of non-aneurysmal subarachnoid hemorrhage as a manifestation of cerebral hyperperfusion syndrome post-carotid endarterectomy is uncommon. We report a case of a patient who presented with headache following carotid endarterectomy for a critically occluded common carotid artery. This progressed to deteriorating consciousness and seizures. Investigations revealed a left cortical non-aneurysmal subarachnoid hemorrhage. Non-aneurysmal subarachnoid hemorrhage is a rare post-operative complication of carotid endarterectomy. Immediate management with aggressive blood pressure control is key to prevent permanent neurological deficits. Cerebral hyperperfusion syndrome (CHS) after carotid revascularization procedures is an uncommon and potentially fatal complication. Pathophysiologically it is attributed to impaired autoregulatory mechanisms and results in disruption of cerebral hemodynamics with increased regional cerebral blood flow (Cardiol Rev 20:84–89, 2012; J Vasc Surg 49:1060–1068, 2009). The condition is characterized by throbbing ipsilateral frontotemporal or periorbital headache. Other symptoms include vomiting, confusion, macular edema, focal motor seizures with frequent secondary generalization, focal neurological deficits, and intraparenchymal or subarachnoid hemorrhage (SAH) (Lancet Neurol 4:877–888, 2005). The incidence of CHS varies from 0.2% to 18.9% after carotid endarterectomy (CEA), with a typical reported incidence of less than 3% in larger studies (Cardiol Rev 20:84–89, 2012; Neurosurg 107:1130–1136, 2007). Uncontrolled hypertension, an arterially isolated cerebral hemisphere, and contralateral carotid occlusion are the main risk factors (Lancet Neurol 4:877–888, 2005; J Neurol Neurosurg Psychiatry 83:543–550, 2012). We present a case of non-aneurysmal SAH after CEA, with focus on its presentation, risk factors, and management.
    SpringerPlus 10/2013; 2(1):571. DOI:10.1186/2193-1801-2-571
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    ABSTRACT: Objectives: Thromboembolic complications are well recognized during the endovascular management of intracranial aneurysms. In this study, we present a case series of 40 patients with intraprocedural thrombotic complications who were treated with intra-arterial eptifibatide (IAE), and a review of the literature. Methods: Twenty-five patients with ruptured intracranial aneurysms (RIA), 10 with unruptured intracranial aneurysms (UIA) and 5 with aneurysmal subarachnoid hemorrhage-induced vasospasm (VSP) received IAE for intraprocedural thrombi during endovascular treatment. Rates of recanalization, strokes, and hemorrhagic complications were assessed. Results: Recanalization was achieved in 96% (24/25) of the RIA patients [72% (18/25) complete; 24% (6/25) partial], in 100% (10/10) of the UIA patients [90% (9/10) complete; 10% (1/10) partial], and in 100% (5/5) of the VSP patients [80% (4/5) complete; 20% (1/5) partial]. Strokes following intraprocedural thrombosis were coil-related (20%, 5/25) or stent-related (12%, 3/25) in RIA patients, stent-related (10%, 1/10) in UIA patients, and heparin-induced thrombocytopenia type II-related (60%, 3/5) or vasospasm-related (20%, 1/5) in VSP patients. There were no intracerebral hemorrhagic complications in UIA. Intracerebral hemorrhage was observed in 20% of the RIA patients (5/25), all of whom had received intra-arterial thrombolytics and/or high-dose heparin infusion in addition to IAE; in 12%, this was external ventricular drain-related (3/25), 4% had parenchymal hematoma type 1 (1/25), and 4% parenchymal hematoma type 2 (1/25). One of the 5 VSP patients, who had received argatroban in addition to IAE, had parenchymal hematoma type 1. No clinically significant systemic hemorrhage was observed in this study. Conclusion: Treatment of thromboembolic complications with IAE during endovascular management of aneurysms was effective in achieving recanalization and overall well tolerated in this series.
    10/2013; 2(1):19-29. DOI:10.1159/000354982
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    ABSTRACT: Abnormal cerebral vasculature can be a manifestation of a vascular malformation or a neoplastic process. We report the case of a patient with angiography-negative subarachnoid hemorrhage (SAH) who re-presented 3 years later with a large intraparenchymal hemorrhage. Although imaging following the intraparenchymal hemorrhage was suggestive of arteriovenous malformation, the patient was ultimately found to have an extensive glioblastoma associated with abnormal tumor vasculature. The case emphasizes the need for magnetic resonance imaging to investigate angiography-negative SAH in suspicious cases to rule out occult etiologies, such as neoplasm. We also discuss diagnostic pitfalls when brain tumors are associated with hemorrhage and abnormal vasculature.
    Frontiers in Neurology 09/2013; 4:144. DOI:10.3389/fneur.2013.00144
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    Adam M H Young · Surya K Karri · Christopher S Ogilvy · Ninghui Zhao ·
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    ABSTRACT: Moyamoya disease is a slowly progressing steno-occlusive condition affecting the cerebrovasculature. Affecting the terminal internal carotid arteries (ICA) and there branches, bilaterally, a resulting in a fine vascular network in the base of the brain to allow for compensation of the stenosed vessels. While there is obvious evidence of the involvement of inflammatory proteins in the condition, this has historically not been acknowledged as a causal factor. Here we describe the fundamental histopathology, genetics, and signaling cascades involved in moyamoya and debate whether these factors can be linked as causal factor for the condition or whether they are simply a secondary result of the ischemia described in the condition. A particular focus has been placed on the multitude of signaling cascades linked to the condition as these are viewed as having the greatest therapeutic potential. As such we hope to draw some novel insight into potential diagnostic and therapeutic inflammatory targets in the condition.
    Frontiers in Neurology 08/2013; 4:105. DOI:10.3389/fneur.2013.00105
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    ABSTRACT: Acute ischemic stroke resulting from intracranial vessel occlusion is associated with high morbidity and mortality. The mainstays of therapy are fibrinolytics and mechanical thrombectomy in properly selected patients. A new Food and Drug Administration-approved technology to perform thrombectomy, retrievable stenting, may provide superior revascularization rates and improved patient outcomes. We analyzed the cumulative human experience reported for the Trevo Pro Retrieval System (Stryker, Kalamazoo, MI, USA) and the Solitaire FR Revascularization Device (ev3, Irvine, CA, USA) as the definitive treatment for acute ischemic stroke. A literature search was undertaken to identify studies using the retrievable stents published up to September 2012. Nineteen studies identified a total of 576 patients treated with either the Trevo (n=221) or Solitaire (n=355) devices. Pooled data analysis identified median baseline National Institutes of Health Stroke Scale scores of 18.5±0.289 (standard error of the mean) and 17.9±0.610, and time to recanalization of 53.9±23.6minutes and 59.0±8.0minutes for the Trevo and Solitaire groups, respectively. Recanalization was variably defined by individual studies, most commonly achieving at least a thrombolysis in cerebral infarction score of 2a-3 or a thrombolysis in myocardial infarction score of 2-3. Revascularization (83%, 82%), mortality (31%, 14%), hemorrhage (8%, 6%), device complications (5%, 6%), and good patient outcomes (51%, 47%) were found with the Trevo and Solitaire devices, respectively. Preliminary analysis reveals excellent clinical outcomes for retrievable stent technology. This may be attributable to both high rates of revascularization with a relatively short time to perfusion restoration.
    Journal of Clinical Neuroscience 08/2013; 20(10). DOI:10.1016/j.jocn.2013.03.015 · 1.38 Impact Factor
  • Christopher J Stapleton · Christopher S Ogilvy ·

    World Neurosurgery 07/2013; 80(3-4). DOI:10.1016/j.wneu.2013.07.008 · 2.88 Impact Factor
  • Cillian T Forde · Surya K Karri · Adam M H Young · Christopher S Ogilvy ·
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    ABSTRACT: The current diagnostic criteria for traumatic brain injury (TBI) are heavily reliant on an accurate clinical history of events. Diagnosis of mild injury relies on one or more of the following: confusion or disorientation, loss of consciousness (LOC) for 30 min or less, post-ictus amnesia for less than 24 h and/or other transient neurological abnormalities and a Glasgow Coma Score (GCS). Given the nature of the condition it is obvious that significant clinical challenges remain to identify in the cases of mild TBI, and additionally to grade more severe forms so that appropriate treatment is received. The lack of clinically useful biomarkers in the serum of TBI patients is a significant barrier to improving their outlook. Discovery of such markers would aid the timely diagnosis of novel and recurrent disease in a minimally invasive manner. A PubMed search was performed to identify studies reporting serum biomarkers in traumatic brain injury. Details regarding the biomarkers analysed, specificity, indications for outcome and statistical significance were recorded. A total of 40 manuscripts reporting 11 biomarkers were identified in the literature. All but a few studies reported statistically significant differences in biomarker expression between groups. We conclude that serum biomarkers of TBI are an effective means for investigating the condition. However, the lack of novel markers identified in this mass of studies highlights the need to adopt new measure of biomarker identification.
    British Journal of Neurosurgery 07/2013; 28(1). DOI:10.3109/02688697.2013.815317 · 0.96 Impact Factor
  • J. Rabinov · A. Yoo · T. Leslie-Mazwi · C. Ogilvy · J. Hirsch ·

    Journal of Neurointerventional Surgery 07/2013; 5(Suppl 2):A66-A66. DOI:10.1136/neurintsurg-2013-010870.131 · 2.77 Impact Factor
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    ABSTRACT: Vertebrovertebral fistulae are rare vascular malformations that uncommonly can rupture to present clinically as intracranial subarachnoid hemorrhage. We report a 69-year-old man presenting following spontaneous apoplectic collapse. Initial workup revealed diffuse, intracranial subarachnoid hemorrhage, intraventricular hemorrhage and hydrocephalus. However, the etiology was not apparent on CT angiography of the head. Catheter-based angiography was performed, demonstrating a single-hole, high-flow vertebrovertebral fistula, arising from the V2 segment and decompressing into both cervical and skull base venous structures. Definitive treatment consisted of endovascular fistula obliteration with a combination of coil and liquid embolic material. The patient made a full neurological recovery. High cervical and skull base fistulae are rare causes of intracranial hemorrhage; endovascular treatment is effective at disconnection of the arteriovenous shunt.
    Journal of Clinical Neuroscience 07/2013; 20(9). DOI:10.1016/j.jocn.2013.01.006 · 1.38 Impact Factor

Publication Stats

8k Citations
1,091.74 Total Impact Points


  • 2002-2015
    • Beth Israel Deaconess Medical Center
      • Division of Neurosurgery
      Boston, Massachusetts, United States
  • 1998-2015
    • Harvard University
      Cambridge, Massachusetts, United States
  • 1992-2015
    • Harvard Medical School
      • • Department of Radiology
      • • Department of Neurology
      Boston, Massachusetts, United States
  • 1988-2014
    • Massachusetts General Hospital
      • • Department of Neurosurgery
      • • Department of Neurology
      • • Neurology of Vision Lab
      Boston, Massachusetts, United States
  • 2013
    • University of Costa Rica
      San José, San José, Costa Rica
    • Thomas Jefferson University
      • Department of Neurological Surgery
      Philadelphia, Pennsylvania, United States
  • 2012
    • Mass General Hospital
      Boston, Massachusetts, United States
    • Partners HealthCare
      Boston, Massachusetts, United States
  • 2011
    • Maria Sklodowska Curie Memorial Cancer Centre
      Gleiwitz, Silesian Voivodeship, Poland
  • 2003
    • Emory University
      Atlanta, Georgia, United States
  • 1990-2003
    • Beverly Hospital, Boston MA
      Beverly, Massachusetts, United States
  • 1996
    • University of Massachusetts Boston
      Boston, Massachusetts, United States
  • 1995
    • Massachusetts Eye and Ear Infirmary
      Boston, Massachusetts, United States
  • 1987-1992
    • The John B. Pierce Laboratory
      New Haven, Connecticut, United States
  • 1986-1988
    • Yale University
      New Haven, Connecticut, United States